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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT lComplete In Triplicate) Permit No. ............... .. ... .................... This permit Expires 1 Yew from Date issued Dots Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regul�ntions: JOB ADDRESS/LOCATION ...... .�?y`_.....4./Y1eckC114............5,' J szIA............ A)..CENSUS TRACT .......................... Owner's Name ...'.. ., a Er w �j1 ...... ......... r ..: Phone . J �' �Q Address o ,Sc37 ` C::A.....�-.............vcity ....slojz fo .................... ............................... r's Name C4k �Conacto .. . 11............goeo................----.License#-�'N'NZ:71....... Phone Installation will serve: Residence J9 Apartment House Commercial❑Trailer Court ❑ / Motel❑Other........./. ...................•............. Number of living units:_._... _.. Number of bedrooms ..-.1.. .Garbage Grinder ............ Lot Size ...ice-�.,X ...................... Water Supply: Public System and name .........1!!!.. t1'...... ,&j l2................... ..........................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loom 0 Clay loam ❑ Hardpan Q Adobe 10 Fill Material ............If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 240 fat,) PACKAGE TREATMENT I ] SEPTIC TANK{ I Size................................................ Liquid Depth .......................... Capacity ------------------•• Type .................... Material...................... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... J/ LEACHING LINE [ j No. of Lines .......I----_-.-- 1 ..... Total Length .......... ---- Length of each Iino_..,.,�.Q....-•--.. ..................S 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Tit Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ ' SEEPAGE PIT [ ) Depth ----------------- Diameter ................ Number -_.......................... Rock Filled Yes ❑ No ❑ Water Table Depth ----•...........................................Rock Size ................................ Distance to nearest: Well ... -.. ..Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# .._.. r._h.€ .............. Date .................................. Septic Tank (Specify Requirements) ...........................................-...........•...........-•----.........._...::..................................... ............. Disposal Field (Specify Requirements) ................................................-3Q....._1,&-A..ZS .------�Nom_-....�1if ..---........ •` 46 '..c ..---•--f2r./------•-•---•-....• -•....................••--- -------------------------------------------.................................................................-............................................................................................ (Draw existing and required addition on reverse side} I hereby certify that 1 have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HoaW District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .......... . .. Owner By --------- /E- ... . ... .......................................... Title .---11116-440041...._ _----- (If other th owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..j._%,K U------ ......7`jFngA . ............... DATE ,�U �z .7 _.... .I...__. BUILDING PERMIT ISSUED ----- .... ......... -.......... . .....,_. . ..... DATE . .. _..:..... 4— ADDITIONAL CO NTS ..... ._ __ - ---- --- •.-.-... ..... .......... .......-- --•...._. .-----.._.-......_........ Fina Inspection by ............ - ......... ......... gate ....EH t^i 13 24 1-68 RevJOA IN LOCAL HEALTH DISTRICT 8/74 3M